Resin Restoration Terms | Class I & II Definitions in Medicine

pros of resin for posterior restorations (5)

- esthetics

- preservation of tooth structure

- adhesion to tooth structure

- low thermal conductivity

- elimination of galvanic currents

cons of resin for posterior restorations (6)

- polymerization shrinkage

- ↓ wear resistance

- post-op sensitivity

- water sorption

- technique sensitivity

- variable degree of conversion

resin vs amalgam longevity

10 yr period: resin composite performs as well as amalgam in posterior restorations

long term success of resin restoration depends on which 5 factors in the mouth

- cavity size

- functional/occlusal stresses

- caries risk

- restoration type

- tooth type

longevity of resin for premolars vs molars

premolars = better longevity than molars

longevity of resin for class I vs class II

class I = better longevity than class II

longevity of resin for small/moderate vs large restorations

small/moderate restorations = better longevity than large restorations

dentist and patient factors influencing longevity of resin composite

- operator skills

- material and technique

- patient OH

main reason for RBC failure is ___ which are responsible for failure ___% of the time

secondary caries

35

3 other reasons for RBC failure other than secondary caries (main reason)

- fracture/ degradation

- tooth fracture

- pain

resin indications

- small/ moderate class I and II

- conservative preparations

- esthetics area

- metal allergy

resin contraindications

- heavy occlusal stress

- isolation issues

- allergy/ sensitivity to resin-based materials

success with direct resin dental composites is based on what 3 broad categories

1. clinician

2. patient

3. material science

clinician role in success with direct resin dental composites

judgement and skill

patient role in success with direct resin dental composites

caries risk, habits, genetics

material science role in success with direct resin dental composites

adhesives, composite, light curing

resin preps are ___ invasive with ___ removal of carious tissue

minimally

selective

class I/II resin preps do not need (4)

- typical resistance

- typical retention

- flat walls (axial, pulpal)

- bevel

resin preps should create a ___ surface with no ___

smooth

unsupported enamel

what type of enamel is included in outline form for resin preps

decalcified chalky flaking enamel

armamentarium

all equipment used in the practice of medicine

armamentarium needed for resin

- FG carbide composite finishing burs

- composite polishing points

- sectional matrix kit

- mylar strips (NEVER for class 2 tho, just resin in general)

- composite finishing strips

trident sectional matrix kit is used for class ___ composite resins

2

clear matrix mylar strips are used for class ___ restorations but never for class ___

3 and 4

2

< ___cm of mylar strip is needed for an average restorations

1

additional instruments that may be useful in manipulating composite resins

- resin instrument

- ball burnisher

- acorn burnisher

- half-hollenbeck

red vs yellow finishing bur

red = step 1, high fluted carbides

yellow = step 2, higher fluted carbides

composite polishing point kit components

finishing points/cups/discs + prismagloss paste

shade selection should be ___ rubber dam placement when tooth is ___

before

hydrated

dehydration increases/decreases ___ of teeth

increases

value

after shade selection ___, ___, and ___ before drilling on tooth

pre-check occlusion

isolate w/ rubber dam

pre-wedge

how do you clean un-instrumented enamel? instrumented enamel?

un-instrumented enamel = flour of pumice or non-fluoridated prophy paste

instrumented enamel = water spray and air

place resin in ___ no more than ___ thick

increments

2mm

how long do you cure each increment of resin?

20 seconds

for resin, contour as

you place resin

once you contour resin, remove wedge/ matrix/ dam and then

check interproximal contacts (visual + floss) and check occlusion

once occlusion and interproximal contacts are good

finish and polish restoration

when you pre-check occlusion, centric stop should be on ___ and not ___

enamel

restoration

garrison sectional matrix system

garrison steps

1. place Garrison sectional matrix

2. place standard wedge

3. place retainer (Garrison system)

what side is retainer/ Garrison system placed on compared to wedge?

prepped tooth side of wedge

can be opposite side in some cases

once you place Garrison retainer verify

shape/ contour of matrix

you may need to burnish metal band

sectional matrix band and gingival seat

matrix band is gingival to gingival seat (proper seal)

true for garrison and triodent

sectional matrix should extend ___ to the anticipated ___ height

occlusal

marginal ridge

for garrison and triodent

triodent sectional matrix system

triodent section matrix system has its own ___ which functions to ___

wedge guard

pre-wedge + provide proximal protection

triodent matrix application steps

1. place matrix

2. place wedge

3. place retainer (triodent system)

once you place triodent retainer verify

shape/ contour + position of sectional matrix

you may need to burnish metal band

pulpal protectors are ___ and are used when distance between resin prep and pulp is ___

bases and liners

less than or equal to 1.5mm

chemical and name brands of pulpal protection

calcium hydroxide (dycal)

RMGI (vitrebond)

when light curing you must complete full curing cycle because

uncured monomer can be leached

light should be ___ to RBC as possible

as close

___mm layer thickness before it's time to cure... this ensures ___

1-2

thorough polymerization

once retainers and matrices have been removed, you can ___ to ensure even curing

cure B/L sides

what can be done clinically to ensure a marginal seal for class 2 restorations?

layer of flowable resin or RMGI can be placed on gingival seat

polymerization shrinkage will vary between ___-___% volume

2.6-7.1%

what direction does shrinkage occur?

shrinkage occurs toward the bulk of the material

stress from polymerization shrinkage may cause

- cusp movement

- enamel cracks

- sensitivity

- debonding/ marginal gap

- bacterial infiltration (micro leakage)

- secondary caries

bond strength and polymerization stress move in ___ directions

opposite (pull against each other)

c factor full name

configuration factor

c factor =

bonded surface/ unbounded surfaces

class 1 c factor if placed in one increment

5

high c factor = more polymerization shrinkage risk

class 2 c factor if placed in one increment

2

bulk fill resin composites can be placed in ___mm increments and are more ___ in color

4-5

translucent

bulk fill resin composites should only be used for ___ teeth b/c they are translucent

posterior

some varieties of bulk fill resin composites must be capped with

conventional RBC

incremental technique for resin placement

see slides, place in 5 triangles to create anatomy

pros of incremental technique for resin placement

- ↓ polymerization shrinkage stress

- proper polymerization (depth of cure)

- creates occlusal anatomy

bulk placement can result in ___; incremental layer can counteract the effects of ___

debonding + stresses

polymerization shrinkage

when placing resin, ___ as you work and be sure material does not pull from ___

contour

internal/ external prep walls

resin finishing steps

1. red --> yellow finishing carbide

2. polishing discs (super snap)

3. finishing strip (sof lex)

4. finishing diamonds

5. enhance system

order for super snap polishing discs

black --> violet --> green --> red

sof-lex finishing strip order

coarse --> fine

after you finish, polish using ___ that is applied with ___

prisma gloss

enhance system

why are thinner layers (1-2mm) of resin better?

less shrinkage effect on tooth

do not overfill ___; overfill ___

resin

amalgam

matrix bands need to be snug at margins to prevent

overhangs and voids

resin = ___ restorations that cost less than ___ restorations

esthetic

ceramic

how does composite resin get its retention?

acid etching + enamel/ dentin adhesive (bond)

aka micro mechanical retention

what other dental materials are resin composites just w/ different chemistries?

- pit and fissure sealants

- bonding agents

major con of resin

occlusal and proximal wear

critical elements w/ resin placement

1. impeccable isolation

2. tissue management

3. proper bonding technique

impeccable isolation

rubber dam... surfaces must be free from saliva and other oral fluids

tissue managements

packing retraction cord (can be treated w/ epi or hemostatic agents)

proper bonding technique for resin

etch, prime, bond (meet requirements of manufacturer)

how to handle resin material properly

- avoid contamination with gloves, rubber dams, syringes

- avoid early photopolymerization with light

why should each layer be no more than 2mm in thickness?

shrinkage of composite resin + curing light penetration

proper finishing and polishing results in

high luster, plaque resistance, stain resistance

not following manufacturer instructions can result in restoration failure b/c it causes

- ↓ physical properties

- ↓ longevity

- ↑ secondary caries

- ↑ sensitivity/ pain

poor isolation can be caused by

no rubber dam, leaking rubber dam, inadequate cotton roll isolation, careless technique, sub gingival prep

solutions to prevent poor isolation

- better technique

- matrix system

- repeat all bonding procedure that happened before contamination

- use a material that does not require bonding

what causes halo white lines adjacent to enamel margins?

- bad contouring/ finishing

- bad etching/ bonding

- high-intensity light curing (causes excessive polymerization stress)

solutions to prevent halo white lines adjacent to enamel margins

- repeat all bonding procedures in sequence

- remove the defect and re-restore

- good finishing techniques (light, intermittent)

- use soft-start (ramping) polymerization curing lights

- *leave & monitor at set intervals for leakage

what causes voids?

- materials that require mixing (self-cure)

- spaces left between increments

- composite (tacky) pulling away from prep

solutions to prevent voids

- more careful technique

- repairing marginal voids by preparing defects and re-restoring (repeating all bonding procedures in sequence)

causes of light/ missing proximal contact

- inadequately contoured matrix band

- inadequate wedging

including PRE-WEDGING (during prep) and during restoration

- matrix band movement during restoration

- matrix band not in direct contact with adjacent proximal surface

- matrix band too thick

- tacky composite pulling away from contact area during insertion

- circumferential matrix band use

solutions to prevent light or missing proximal contacts

- contour matrix band

- matrix contacts adjacent tooth

- firm wedging (pre-wedging during prep + during restoration)

- use sectional matrix system

- use hand instrument to hold matrix while placing increments

- use specialized (triangular) light curing tips instrument to hold matrix in place while placing increments

- careful insertion technique

causes of inaccurate shade selection

- inappropriate operator lighting while selecting shade

- selection of shade after tooth has been dried

- shade tab not matching the actual composite shade

- wrong shade chosen

solutions to prevent inaccurate shade selection

- natural light when selecting

- select shade first (before isolation)

- pre-op shade verification on tooth (curing, then removing)

- know zones of different shades for natural teeth

causes of poor retention

- contamination of operating field

- poor bonding technique

- use of incompatible bonding material